Focus and Attention Problems

Whether you’ve had a diagnosis of ADD, ADHD or OCD or you just know you struggle with keeping on track, being distractable, having difficulty following conversations, remembering what to do next. 

We have had decades of experience working with this issue and there is a great deal of scientific research on the impact neurofeedback can have on these problems.

Here are some of those studies.

Neurofeedback for ADD/ADHD, OCD, etc.

Infra-Low Frequency Neurofeedback in Application to ADHD [pdf]
by Roxana Sasu, MD and Siegfried Othmer, Ph.D.
This manuscript is an augmented version of a chapter in Restoring the Brain, Second Edition (Taylor and Francis)

Introduction

The ADHD spectrum has been the primary clinical application of neurofeedback for over thirty years. In Chapter 2, review of the early research history established that the traditional SMR-beta protocols of EEG biofeedback were quite effective in managing the canonical symptoms of ADHD. Our own role in that development is covered in detail in two book chapters dating back to 1999.1,2 Six comparison studies have now been done that unanimously find an essential equivalence between EEG training in the classical manner and state-of-the art pharmacological management. These comparisons typically relied strongly on the results of continuous performance tests of attention (CPTs), which primarily test for inattention and impulsivity. These tests don’t give us a handle on the hyperactivity component or distractibility, for which one needs to rely on the observations of parents, teachers, or trained observers. These have their obvious shortcomings. Nevertheless, the essential findings are no longer in any doubt. Neurofeedback is competitive with standard medical treatment in the management of ADHD.

In recognition of this substantial body of evidence, the American Academy of Pediatrics rated neurofeedback as having Level 1 efficacy in application to ADHD.3 (Under political pressure, the AAP subsequently softened this recognition without further investigation. Research support for the original assignment was never called into question.) In support, recent brain imaging research was cited in addition to the clinical studies.4 This research documents the impact of neurofeedback training on the functional connectivity of neuronal networks. More recently, the adjudicating body in German psychiatry has likewise given recognition to neurofeedback in this application. The effect will be the gradual recruitment of neurofeedback into the arsenal of remedies for ADHD around the world.

Efficacy of Neurofeedback Treatment in ADHD: the Effects on Inattention, Impulsivity and Hyperactivity: a Meta-Analysis [pdf]
by Arns M, de Ridder S, Strehl U, Breteler M and Coenen A
Journal of Clinical EEG & Neuroscience, July, 2009

ABSTRACT
Since the first reports of neurofeedback treatment in Attention Deficit Hyperactivity Disorder (ADHD) in 1976, many studies have investigated the effects of neurofeedback on different symptoms of ADHD such as inattention, impulsivity and hyperactivity. This technique is also used by many practitioners, but the question as to the evidence-based level of this treatment is still unclear. In this study selected research on neurofeedback treatment for ADHD was collected and a meta-analysis was performed.

Both prospective controlled studies and studies employing a pre- and post-design found large effect sizes (ES) for neurofeedback on impulsivity and inattention and a medium ES for hyperactivity. Randomized studies demonstrated a lower ES for hyperactivity suggesting that hyperactivity is probably most sensitive to nonspecific treatment factors.

Due to the inclusion of some very recent and sound methodological studies in this meta-analysis, potential confounding factors such as small studies, lack of randomization in previous studies and a lack of adequate control groups have been addressed, and the clinical effects of neurofeedback in the treatment of ADHD can be regarded as clinically meaningful. Three randomized studies have employed a semi-active control group which can be regarded as a credible sham control providing an equal level of cognitive training and client-therapist interaction. Therefore, in line with the AAPB and ISNR guidelines for rating clinical efficacy, we conclude that neurofeedback treatment for ADHD can be considered “Efficacious and Specific” (Level 5) with a large ES for inattention and impulsivity and a medium ES for hyperactivity.

Place of EEG Biofeedback for ADHD [pdf]
by Hirshberg LM
Expert Review Neurotherapeutics, 7(4), 315-319

ABSTRACT
Although methodological weaknesses limited early research into electroencephalograpic (EEG) biofeedback (EBF) for treatment of attention-deficit/hyperacticity disorder (ADHD), recent stronger randomized controlled trials have provided substantial, but not yet conclusive, empirical support. Additional support is found in research on functional magnetic resonance imaging (fMRI) feedback and brain-computer interface (BCI) models which involve feedback-guided learning to achieve control over neural activation.

EEG Biofeedback in the Treatment of Attention Deficit Hyperactivity Disorder [abs.]
by Friel PN
Alternative Medicine Review, Volume 12, #2, June, 2007, pp146-151

ABSTRACT
Electroencephalogram (EEG) biofeedback, also known as neurofeedback, is a promising alternative treatment for patients with attention deficit/hyperactivity disorder (AD/HD). EEG biofeedback therapy rewards scalp EEG frequencies that are associated with relaxed attention, and suppresses frequencies associated with under- or over-arousal.

Electroencephalographic Biofeedback in the Treatment of Attention-Deficit/Hyperactivity Disorder [abs.]
by Monastra VJ, Lynn S, Linden M, Lubar JF, Gruzelier J, LaVaque TJ

ABSTRACT
Historically, pharmacological treatments for attention-deficit/hyperactivity disorder (ADHD) have been considered to be the only type of interventions effective for reducing the core symptoms of this condition. However, during the past three decades, a series of case and controlled group studies examining the effects of EEG biofeedback have reported improved attention and behavioral control, increased cortical activation on quantitative electroencephalographic examination, and gains on tests of intelligence and academic achievement in response to this type of treatment.

Electroencephalographic Biofeedback (Neurotherapy) as a Treatment for Attention Deficit Hyperactivity Disorder: Rationale and Empirical Foundation [abs.]
by Monastra VJ

ABSTRACT
During the past three decades, electroencephalographic (EEG) biofeedback has emerged as a nonpharmacologic treatment for attention-deficit/hyperactivity disorder (ADHD). This intervention was derived from operant conditioning studies that demonstrated capacity for neurophysiologic training in humans and other mammals and targets atypical patterns of cortical activation that have been identified consistently in neuroimaging and quantitative EEG studies of patients diagnosed with ADHD.

Treatment of Attention Deficit Hyperactivity Disorder with Neurotherapy [abs.]
by Nash JK

ABSTRACT
Significant public health concerns exist regarding our current level of success in treating ADHD. Medication management is very helpful in 60-70% of patients. Side effects, lack of compliance and the fact that stimulant medications cannot be given late in the day limit the benefits largely to school hours.

Review of the Literature Regarding the Efficacy of Neurofeedback in the Treatment of Attention Deficit Hyperactivity Disorder [abs.]
by Lingenfelter JE

ABSTRACT
The following is a review of the most recent literature regarding the efficacy of EEG Neurofeedback in the treatment of attention deficit hyperactivity disorders.

Update on Attention-Deficit/Hyperactivity Disorder [abs.]
by Campbell Daley K

ABSTRACT
In her recent paper, Update on Attention-Deficit/Hyperactivity Disorder, published in Current Opinion in Pediatrics, Katie Campbell Daley reviewed the research and practice standards on treatment of ADHD. Dr. Campbell is on the staff of the Department of Medicine, Children’s Hospital Boston and in the Department of Pediatrics of the Harvard Medical School. Her conclusion: “Overall, these findings support the use of multi-modal treatment, including medication, parent/school counseling, and EEG biofeedback, in the long term management of ADHD, with EEG biofeedback in particular providing a sustained effect even without stimulant treatment… Parents interested in non-psychopharmacologic treatment can pursue the use of complementary and alternative therapy. The therapy most promising by recent clinical trials appears to be EEG biofeedback.”

For more information please visit…

ISNR

The International Society for Neuronal Regulation and Research        a well maintained bibliography of neurofeedback research

EEGInfo

A well organized page on the major studies on neurofeedback and its applications.